Wednesday, February 6, 2019

CMS Issues New PDPM Related MDS Draft Data Specifications Effective October 1, 2019

Dan Ciolek

On February 5, the Centers for Medicare and Medicaid Services (CMS) posted on their MDS 3.0 Technical Information Webpage a new draft version (V3.00.0) of the MDS 3.0 Data Specifications.  This version is scheduled to become effective October 1, 2019. 

These specifications are used for software developers and vendors to update SNF PPS grouper, MDS, electronic health record, and billing systems to align with annual updates to the MDS-RAI (yet to be issued) and SNF PPS billing requirements. 

Note that there are many significant changes, to align with the transition to the new Skilled Nursing Facility Prospective Payment System (SNF PPS) from the Resource Utilization Groups, Version 4 (RUG-IV) to the Patient Driven Payment Model (PDPM).  These changes include the removal of eight RUG-IV assessment item sets (NS, NSD, NO, NOD, SS, SSD, SO, SOD), the addition of two new PDPM assessment item sets (IPA – Interim Payment Assessment and OSA – Optional State Assessment), and item additions in Sections A, GG, I, J, O and Z. See this link for the draft MDS 3.0 Item Sets v1.17 for October 1, 2019) that were issued on January 3.  The MDS draft data specifications also accommodate the utilization of the PDPM grouper (not issued yet) , which also begins on October 1, 2019.

In addition, a new version (V1.04.0) of the MDS 3.0 CAT Specifications was posted. This version is also scheduled to become effective October 1, 2019. The specification for CAT 12 (Nutritional Status) has been updated in accordance with the changes in V3.00.0 of the MDS 3.0 Data Specifications.

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